Treating mental health conditions is a key component of the future of legal psilocybin services in Oregon. But businesses hoping to enter the marketplace are pressing state regulators to allow creative offerings, too.
Psychedelic mushrooms were touted as a panacea for Oregon’s mental health crisis in 2020, when voters passed a first-in-the-nation measure legalizing the supervised use of psilocybin in state-regulated settings. Backed by Portland-area therapists Tom and Sheri Eckert, the language of Measure 109 promised to improve the physical, mental and social well-being of Oregonians by teaching people about “the safety and efficacy of psilocybin in treating mental health conditions.”
Yet as Oregon finalizes the regulatory framework this year for a 2023 start date, what comes next is unlikely to look much like mainstream mental health treatment on a therapist’s couch. Regulators crafting the rules in Oregon for legal psychedelic mushrooms envision a convention-defying approach that could set the standard for other jurisdictions, as well as create a whole new job category in Oregon: that of the licensed, professional psilocybin facilitator.
“If they can pull this off the way we really believe they can, it’s going to create quite a precedent — and I think quite an important precedent — for other states and hopefully other countries to follow,” says Todd Shapiro, CEO of Red Light Holland, which offers psychedelic mushroom products legally in the Netherlands, and is part of a joint venture with Halo Collective, to potentially provide psilocybin services in Oregon.
Psychedelics for centuries have had spiritual meaning and other significance in many Indigenous cultures, but magic mushrooms are having an especially potent modern moment. Their broader acceptance may have been eased by the successful implementation of cannabis in Oregon and other states, but it’s also aided in part by books like How to Change Your Mind, the 2018 bestseller on psychedelics by food writer Michael Pollan, and the 2019 documentary “Fantastic Fungi,” an exploration now on Netflix of the vital role of mycelium networks in the biosphere.
Both the film and book pay homage to a half-century’s work by scientists to legitimize the study of psilocybin and other potentially mind-altering hallucinogenic substances. In recent years, medical researchers in the U.S. have focused on the potential therapeutic benefits of psilocybin. One particular emphasis has been on veterans suffering from post-traumatic stress disorder. Other studies include efforts at the University of Washington School of Medicine to determine whether treating medical professionals with depression brought on by the stressors of Covid-19 can, in concert with psychotherapy, help them cope with work-related trauma. Recently, Johns Hopkins Medicine received the first federal grant in 50 years for psychedelic treatment research. It’s a $4 million study to test the effects of psilocybin on helping smokers quit. Johns Hopkins in 2020 also released a small but influential study showing that in adults with major depression, two doses of psilocybin, given with supportive psychotherapy, “produced rapid and large reductions in depressive symptoms.”
Under Oregon’s proposed regulations, however, no psychotherapy will be required. After a preparatory intake appointment with a facilitator, just about anyone over 21 will be able to consume psilocybin in state-licensed settings for whatever purpose they desire. And that’s by design, says Dr. Rachel Knox, a cannabinoid medicine specialist in Portland who co-chairs the equity committee of the Oregon Psilocybin Advisory Board.
“Americans are sicker than ever before, despite trillions of dollars spent on medical care, clinical research and drug development,” Knox says. “It is time that we recognize that healing services come in many more forms than we realize, and Measure 109 was written in such a way to lawfully explore this. This is the promise of Measure 109, and I believe it will make a remarkable difference in the lives of many Oregonians and those who will come to visit.”
In the proposed regulations, psilocybin users are “clients,” not “patients.” Psilocybin services won’t be considered therapy in a conventional sense, and the services won’t need to be offered by a licensed therapist — although some mental health care providers may choose to offer psilocybin themselves, as facilitators. The facilitators won’t act as health care providers, or provide medical care beyond general support.
Psilocybin will mostly be administered instead by facilitators who commit to a 120-hour state-certified training program and apply for a state license. They’ll be trained in the “physical, psychological, and spiritual effects of psilocybin, along with education on ethics, equity, history, and culture,” writes Mason Marks, a law professor in Portland who leads the Project on Psychedelics Law and Regulation at Harvard Law School, and who also sits on the Oregon Psilocybin Advisory Board.
Instead of seeing facilitators as “inexperienced amateurs,” Marks says, critics should instead view them as “the pioneers of a new profession.” Facilitators “are going to be interesting,” says Dave Kopilak, who authored Measure 109 as well as the state measure that in 2014 legalized recreational marijuana in Oregon. Kopilak, of Portland’s Emerge Law Group, says the firm is already advising clients on creative potential offerings from facilitators.
Attorney Dave Kopilak, who authored Measure 109. Photo: Jason E. Kaplan
“Facilitators are going to be interesting,” Kopilak says. “They can own the service center. They can be employees of a service center. They could just work at a service center, or they could be kind of freelance, independent contractors who run around with their own client base and actually bring clients to a service center. So a facilitator could be its own business. And wouldn’t it be really interesting if clients kind of glom onto a facilitator, like, ‘This facilitator is an awesome facilitator.’”
Psilocybin services are far more likely to look like the offerings from a healing shaman or at an Indigenous ceremony or a retreat center — or even a yoga studio, float pool or upscale herbal apothecary. Expect to see a lot of “psychedelic hospitality” emerge in Oregon as businesses look for innovative ways to enter a marketplace that has limited retail offerings beyond the experience of consuming psilocybin, says Jon Dennis, a lawyer in Eastern Oregon who consults for Psychedelics Go, an advisory firm for potential investors in the state’s emerging psilocybin marketplace. Psilocybin cannot be sold for use outside of licensed service centers.
At Red Light, company leaders envision something like an espresso bar or community arts center, where clients can stop in for microdoses of less than 3 grams of psilocybin. The company recently commissioned a market-research report looking at what consumers want; opportunities to microdose ranked high, in part because it costs less and is not as intense as a larger dose of mushrooms that may lead to hallucinations.
Red Light’s executives and many other people seeking to manufacture psilocybin products or open psilocybin service centers have urged the Oregon Psilocybin Advisory Board to consider recommending that the final state regulations allow for microdosing. They argue that not all clients will want to partake in larger doses that require them to stay under the supervision of a facilitator all day, and that one facilitator could oversee many more microdosing clients at a time.
“That’s what I find most exciting about this piece of regulation, that it allows for a wide variety of approaches,” Marks says. “So that can be something that resembles kind of a sterile office-space-like environment where a person is in a white lab coat, if that’s what you want. Or it could be something that occurs out in the mountains or the forest. And you could pursue it for a variety of reasons, whether it’s to improve your physical or mental wellness or to heal a relationship. Or if someone’s just trying to explore the meaning of life, that’s a perfectly valid reason to do this.”
Because trained facilitators aren’t required to have a medical or therapeutic background or education beyond high school, the regulations may offer a space for people outside of mainstream health care modalities to offer psilocybin services. It may invite a more diverse set of facilitators with the cultural sensitivity, racial background and lived experience to help guide populations that may not have been well served by conventional mental health care providers, Knox says.
“Western medicine has co-opted the meanings of health, healing, health care services and health care providers,” Knox says. She states that it would be the job of the Psilocybin Services Program to ensure that all licensed facilitators are proficient in their craft in a way that assures their clients and the public that safety and quality standards are in effect.
Potential operators continue to watch closely as the state develops those standards. Up first, regulators are expected to consider standards for manufacturers and for facilitator license training programs. The measure requires the Oregon Health Authority to adopt rules for the production of psilocybin and the facilitation of psilocybin services no later than Dec. 31. They must begin accepting applications for licensure on Jan. 2, 2023.
“For people who are looking to open kind of right at the beginning, the clock’s ticking,” Dennis says. “If they’re serious about being quick and early, then now’s time to start planning.”
What Is Microdosing?
As Oregon considers how to oversee the legal, therapeutic use of psilocybin, state regulators will have to decide on what’s known as microdosing, the practice of taking smaller, non-hallucinogenic doses of psychedelic mushrooms.
Unregulated microdosing is already a popular use of psilocybin, says Dr. Chris Stauffer, an assistant professor of psychiatry at OHSU, who sits on the research subcommittee of the Oregon Psilocybin Advisory Board. More studies on microdosing are emerging rapidly, Stauffer recently told fellow research committee members, but so far, the practice has “outpaced the scientific evidence of the potential benefits — and research on the risks.”
But there’s also some research of concern that suggests microdosing psilocybin could contribute to cardiac valvulopathy, a thickening of heart valves. It’s an irreversible side effect, notes Dr. Atheir Abbas, assistant professor of behavioral neuroscience and psychiatry in the OHSU School of Medicine, and co-chair of the research committee.
“It’s really not clear,” says Abbas. “We don’t really know if it’s safe. We’re not saying it’s not safe, but there’s not enough data. There is a reason to be concerned, but we don’t really know.”
The legendary drug researcher James Fadiman, author of The Psychedelic Explorer’s Guide, suggested to the advisory board that the nonaddictive nature of psilocybin is a far better alternative to stimulants like Adderall. Microdosing is an intermittent or occasional practice, Fadiman says, “and built into the ideology is the notion that one should stop using it for a week or a month if one has been using it for several months.”
— Erika Bolstad
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